Pseudoprogression and Hyperprogression as New Forms of Response to Immunotherapy

Frélaut, Maxime; Rusquec, Pauline du; Moura, Alexandre de; Tourneau, Christophe Le; Borcoman, Édith

doi:10.1007/s40259-020-00425-y

Cited by 58 publications

(48 citation statements)

References 84 publications

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“…A metanalysis published by Kim et al [ 44 ] evaluated a total of 217 HPD cases of 1519 cancer patients. Considering the lack in HPD definition, its incidence ranged from 1% to 30%, in line with Frelaut et al [ 23 ], reporting a range from 7% and 29%. Authors identified age (> 65 years), gender (female), aggressive primary tumor (high recurrence rate, > 2 metastatic sites), histological and immunological profiling ( i.e.…”

Section: Hyperprogressionsupporting

confidence: 75%

“…Pseudoprogression has been described in different types of tumors, mainly in melanoma patients but also in non-small lung cell carcinoma (NSCLC) (Figure 3 ), renal cancer (RCC), urothelial cancer, uveal melanoma, Merkel cell carcinoma, mesothelioma, Hodgkin lymphoma, and head and neck squamous cell carcinoma (HNSCC)[ 23 ] and it can also occur in metastatic lesions and some oncologic patients with pleural effusion and ascites[ 14 , 24 - 29 ].…”

Section: Pseudoprogressionmentioning

confidence: 99%

“…Interestingly, for patients treated beyond progression, no increase in immune-related toxicity was reported. Furthermore, patients experiencing pseudoprogression had longer overall survival (OS) compared with standard progressive disease (PD), suggesting that patients who present with pseudoprogression can effectively obtain benefit from treatment beyond progression[ 23 ].…”

Section: Pseudoprogressionmentioning

confidence: 99%

See 2 more Smart Citations

Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy

Ippolito¹,

Maino²,

Ragusi³

et al. 2021

WJCO

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In 2017, immune response evaluation criteria in solid tumors (iRECIST) were introduced to validate radiologic and clinical interpretations and to better analyze tumor’s response to immunotherapy, considering the different time of following and response, between this new therapy compared to the standard one. However, even if the iRECIST are worldwide accepted, to date, different aspects should be better underlined and well reported, especially in clinical practice. Clinical experience has demonstrated that in a non-negligible percentage of patients, it is challenging to determine the correct category of response (stable disease, progression disease, partial or complete response), and consequently, to define which is the best management for those patients. Approaching radiological response in patients who underwent immunotherapy, a new uncommon kind of target lesions behavior was found. This phenomenon is mainly due to the different mechanisms of action of immunotherapeutic drug. Therefore, new groups of response have been described in clinical practice, defined as “atypical responses,” and categorized into three new groups: pseudoprogression, hyperprogression, and dissociated response. This review summarizes and reports these patterns, helping clinicians and radiologists get used to atypical responses, in order to identify patients that respond best to treatment.

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Section: Hyperprogressionsupporting

confidence: 75%

Section: Pseudoprogressionmentioning

confidence: 99%

Section: Pseudoprogressionmentioning

confidence: 99%

See 1 more Smart Citation

Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy

Ippolito¹,

Maino²,

Ragusi³

et al. 2021

WJCO

View full text Add to dashboard Cite

show abstract

“…Evaluation of therapeutic response to immunotherapy can be more challenging than with conventional cytotoxic therapy, given the different patterns of tumor response. Pseudoprogressions (PSPD)with initial flare-up followed by prolonged responsesmust be differentiated from hyperprogressions in which the tumor increase continues (22). Several radiologic criteria were developed to define HPD (19) Treated four years ago by subtotal gastrectomy with perioperative FOLFOX chemotherapy for a localized gastric cancer (ypT3N1).…”

Section: Discussion Hyperprogression Definitionmentioning

confidence: 99%

Hyperprogressive Disease After Combined Anti-PD-L1 and Anti-CTLA-4 Immunotherapy for MSI-H/dMMR Gastric Cancer: A Case Report

et al. 2021

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Immune checkpoint inhibitors (ICI) have been developed in gastric adenocarcinomas and approved in first-line metastatic setting (in combination with chemotherapy) as well as in pretreated patients. Microsatellite instability-high (MSI-H) tumors are predicted to derive high benefit from ICI but data in gastric locations are limited. Here, we describe the case of a 68-year old patient with stage IV MSI-H gastric adenocarcinoma, referred to our center to receive immunotherapy after failure of standard of care (surgery with perioperative platin-based chemotherapy and paclitaxel plus ramucirumab at disease progression). The patient received one injection of durvalumab and tremelimumab and was hospitalized eighteen days after because of occlusive syndrome. The CT scan showed hyperprogression of the lymph nodes and hepatic lesions, compressing the gastric stump. He died few days later. Molecular analyses did not explain this outcome. To our knowledge, this is one of the first reported cases of hyperprogressive disease after combined ICI for a patient with MSI-H tumor. We review the potential causes and discuss the emerging literature regarding predictive factors of hyperprogression in the particular subset of MSI-H patients. If some data were available in retrospective studies, validation of strong predictive factors is needed to avoid such dramatic evolutions.

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“…They all share the common concept of “unconfirmed progressive disease,” allowing the continuation of treatment post-progression in case of suspected pseudo-progression. In that latter situation, patients continue treatment until the next tumor evaluation that either confirms disease progression (and treatment failure) or suggests pseudo-progression [ 21 ]. However, RECIST remains the reference in clinical research, with immune-related criteria being used as secondary endpoints.…”

Section: Efficacy Endpoints: a Historical Perspectivementioning

confidence: 99%

Drug Development in Tissue-Agnostic Indications

Rusquec

Tourneau

2021

Cancers

Self Cite

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A better understanding of cancer biology has led to the development of targeted therapies specifically designed to modulate an altered molecular pathway in the cancer cells or their microenvironment. Despite the identification of molecular targets across cancer types, most of targeted therapies were developed per cancer type. In this ancestral paradigm, randomization was the gold-standard approach for market access. Randomization of large patient populations was feasible for drugs developed in common cancer types but more challenging in rare cancer types. The traditional paradigm of drug development in oncology was further challenged by the ever-expanding molecular segmentation of cancer with ever-smaller subgroups of patients who might benefit from specific targeted therapies or immunotherapies and the identification of molecular alterations against which drugs may be effective across cancer types. In this novel drug development paradigm, novel ways of evaluating the efficacy of drugs are highly needed in these small patient populations. One approach is to use each patient as his/her own control by comparing the efficacy of a drug to the efficacy of prior treatments received. This approach allows to overcome patient heterogeneity, especially in a tissue-agnostic drug development paradigm.

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Pseudoprogression and Hyperprogression as New Forms of Response to Immunotherapy

Cited by 58 publications

References 84 publications

Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy

Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy

Hyperprogressive Disease After Combined Anti-PD-L1 and Anti-CTLA-4 Immunotherapy for MSI-H/dMMR Gastric Cancer: A Case Report

Drug Development in Tissue-Agnostic Indications

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